Bartow Regional Ends Use Of On-Call Gynecologists

Bartow Regional Medical Center has stopped paying gynecologists to be on call, which means women presenting with urgent gynecologic situations its emergency room doctors can't handle will be transferred.

By ROBIN WILLIAMS ADAMSTHE LEDGER

BARTOW | Bartow Regional Medical Center has stopped paying gynecologists to be on call, which means women presenting with urgent gynecologic situations its emergency room doctors can't handle will be transferred.Chief Executive Officer Troy DeDecker notified the two doctors it had on call, Dr. Jake Booker and Dr. Ralph Nobo, that their on-call contract was being terminated. Both remain on the medical staff and can admit and treat gynecology patients there.Hospitals nationwide are dealing with difficult decisions on what services they can afford in the wake of reduced government funding for programs like Medicaid and more uninsured patients.The current decision at Bartow Regional has the potential for added sensitivity in view of the community furor that developed when the hospital discontinued its obstetrics program in July 2007."Because we do not provide obstetrics care, and based on the experience we have seen in our community, it is just simply no longer appropriate to pay for gynecology call," Chief Executive Officer Troy DeDecker said."We do pay for call for services where the need is compelling."Nobo, a longtime BRMC physician who fought the hospital's obstetrics decision, blasted the latest action."The emergency room cannot manage major gynecologic emergencies," Nobo said, listing as examples ectopic pregnancies, miscarriages and a condition in which the ovary has enlarged and twisted, requiring surgery.With conditions such as pelvic inflammatory disease, he said, emergency doctors can benefit from consulting with a gynecologic specialist on the right treatments to use to preserve a woman's fertility."You need to treat this promptly and aggressively," Nobo said.DeDecker said the number of cases isn't large enough for BRMC to pay on-call gynecologists."There are a few (specialties) we need to compensate call for but gynecology is not one of them," DeDecker said. "There are just not a lot of gynecologic emergencies. It's not a high-volume specialty in the emergency room."He praised emergency department physicians' capabilities at handling more than 33,000 overall visits last year. "This is absolutely the right decision for our patients and will help ensure the proper deployment of our resources," DeDecker said. Nobo said the emergency doctors don't have the specialized skills needed for gynecologic emergencies.Polk County Emergency Medical Services will be aware BRMC doesn't have gynecology call, DeDecker said. Women who arrive by other means and need more-specialized care will be stabilized and transferred promptly."The care of the patient will not be compromised," DeDecker said.Nobo said their care will be delayed and women will end up paying more. He circulated a petition, which had nine doctors' signatures Monday, asking Bartow Regional's parent company to reconsider."The following physicians have appreciated that BRMC has had the availability of GYN consultation and treatment," it said, calling that "an extremely important component of our hospital and a necessity to the women of the community."Nobo said he and Booker each volunteered five days a month to take call, then were paid to take call on the other days. They worked separate days, being paid $550 for each on-call day. That came to almost $135,000 a year, DeDecker said, money which he said could be spent on other needs at the hospital. The contract began in May 2010. Booker said this is an issue facing many smaller hospitals."There are instances where care can be compromised, but these women can be transferred to Tampa or Lakeland," he said.Booker is the only gynecologist taking gynecologic emergency calls at Lake Wales Medical Center, which also faced community protest when it discontinued obstetrics in 1999.Booker said he is "frustrated with the situation" at BRMC and "sad in some respects," but he added that the hospital "has done other good things."DeDecker said the hospital recently acquired a daVinci surgical system, costing more than $1 million, on which Booker does some surgeries.Both gynecologists said the numbers BRMC used to measure demand were lower than the actual number of calls they received from other doctors seeking consultation. BRMC was looking predominantly at emergencies that required a gynecologist to come to BRMC, DeDecker said. Candy Mercer, one of the Bartow area residents who opposed the obstetrics unit closing, said she is upset about the hospital losing another service."I have women calling me all the time, asking what we're going to do about it," Mercer said.

[ Robin Williams Adams can be reached at robin.adams@theledger.com or 863-802-7558. ]